2.

Types of blood transfusion

Whole Blood
Storage
4 for up to 35 days

Indications
Massive Blood Loss/Trauma/Exchange Transfusion

Considerations
Use filter as platelets and coagulation factors will not be active after 3-5 days Donor and recipient must be ABO identical

RBC Concentrate
Storage
4 for up to 42 days, can be frozen

Indications
Many indicationsie anemia, hypoxia, etc.

Considerations
Recipient must not have antibodies to donor RBCs (note: patients can develop antibodies over time) Usual dose 10 cc/kg (will increase Hgb by 2.5 gm/dl) Usually transfuse over 2-4 hours (slower for chronic anemia

Platelets
Storage
Up to 5 days at 20-24

Indications
Thrombocytopenia, Plt <15,000 Bleeding and Plt <50,000 Invasive procedure and Plt <50,000

Considerations
Contain Leukocytes and cytokines 1 unit/10 kg of body weight increases Plt count by 50,000 Donor and Recipient must be ABO identical

Plasma and FFP

ContentsCoagulation Factors (1 unit/ml) Storage
FFP--12 months at 18 degrees or colder

Indications
Coagulation Factor deficiency, fibrinogen replacement, DIC, liver disease, exchange transfusion, massive transfusion

Considerations
Plasma should be recipient RBC ABO compatible In children, should also be Rh compatible Account for time to thaw Usual dose is 20 cc/kg to raise coagulation factors approx 20%

Cryoprecipitate
Description
Precipitate formed/collected when FFP is thawed at 4

Storage
After collection, refrozen and stored up to 1 year at -18

Indication
Fibrinogen deficiency or dysfibrinogenemia vonWillebrands Disease Factor VIII or XIII deficiency DIC (not used alone)

Considerations
ABO compatible preferred (but not limiting) Usual dose is 1 unit/5-10 kg of recipient body weight

Granulocyte Transfusions
Prepared at the time for immediate transfusion (no storage available) Indications severe neutropenia assoc with infection that has failed antibiotic therapy, and recovery of BM is expected Donor is given G-CSF and steroids or Hetastarch Complications
Severe allergic reactions Can irradiate granulocytes for GVHD prevention

Leukocyte Reduction Filters

Used for prevention of transfusion reactions Filter used with RBCs, Platelets, FFP, Cryoprecipitate Other plasma proteins (albumin, colloid expanders, factors, etc.) do not need filtersNEVER use filters with stem cell/bone marrow infusions May reduce RBCs by 5-10% Does not prevent Graft Verses Host Disease (GVHD)

RBC Transfusions
Preparations
Type
Typing of RBCs for ABO and Rh are determined for both donor and recipient

Screen
Screen RBCs for atypical antibodies Approx 1-2% of patients have antibodies

Crossmatch
Donor cells and recipient serum are mixed and evaluated for agglutination

RBC Transfusions
Administration
Dose
Usual dose of 10 cc/kg infused over 2-4 hours Maximum dose 15-20 cc/kg can be given to hemodynamically stable patient

Procedure
May need Premedication (Tylenol and/or Benadryl) Filter useroutinely leukodepleted MonitoringVS q 15 minutes, clinical status Do NOT mix with medications

Complications
Rapid infusion may result in Pulmonary edema Transfusion Reaction

Platelet Transfusions
Preparations
ABO antigens are present on platelets
ABO compatible platelets are ideal This is not limiting if Platelets indicated and type specific not available

Rh antigens are not present on platelets

Note: a few RBCs in Platelet unit may sensitize the Rhpatient

Platelet Transfusions
Administration
Dose
May be given as single units or as apheresis units Usual dose is approx 4 units/m2in children using 1-2 apheresis units is ideal 1 apheresis unit contains 6-8 Plt units (packs) from a single donor

Procedure
Should be administered over 20-40 minutes Filter use Premedicate if hx of Transfusion Reaction

ComplicationsTransfusion Reaction